Pain Management During Radiotherapy for Head and Neck Cancers

  • Charu Singh


Head and neck cancers is the term broadly used for cancers arising from the epithelial lining of the upper aerodigestive tract, mainly the oral cavity, pharynx, larynx, salivary glands, and paranasal sinuses. Most common pathology is squamous cell carcinoma. Tobacco, areca nut, alcohol consumption, and poor nutrition along with human papillomavirus and Epstein-Barr virus are being reported as causative reasons for oral cancers [1].


  1. 1.
    IARC Working Group on the Evaluation of Carcinogenic Risks to humans. Alcohol consumption and ethyl carbamate. IARC Mongor Eval Carcinog Risks Hum. 2010;96:3–1383.Google Scholar
  2. 2.
    Binczak M, Navez M, Perrichon C, et al. Management of somatic pain induced by head and neck cancer treatment: definition and assessment. Guidelines of the French Oto-Rhino-Laryngology- Head and Neck Surgery Society. Eur Ann Otorhinolaryngol Head Neck Dis. 2014;11:243–7.CrossRefGoogle Scholar
  3. 3.
    Macfarlane TV, Wirth T, Ranasinghe S, Ah-See KW, Renny N, Hurman D. Head and neck cancer pain: systematic review of prevalence and associated factors. J Oral Maxillofac Res. 2012;3:e1.CrossRefGoogle Scholar
  4. 4.
    Breivik H, Cherny N, Collett B, et al. Cancer-related pain: a pan European survey of prevalence, treatment, and patient attitudes. Ann Oncol. 2009;20:1420–33.CrossRefGoogle Scholar
  5. 5.
  6. 6.
    Williams JE, Yen JT, Parker G, Chapman S, Kandikattu S, Barbachano Y. Prevalence of pain in head and neck cancer out-patients. J Laryngol Otol. 2010;124:767–73.CrossRefGoogle Scholar
  7. 7.
    International Association for the Study of Pain. Classification of chronic pain. Description of chronic pain syndromes and definition of pain terms. Seattle: IASP Press; 1994.Google Scholar
  8. 8.
    Dworkin RH, et al. Review and recommendations: research design considerations for confirmatory chronic pain clinical trials: IMMPACT recommendations. Pain. 2010;149:177–93.CrossRefGoogle Scholar
  9. 9.
    Brief Pain Inventory-Short form.
  10. 10.
    Bennett M. The LANSS pain scale: the Leeds assessment of neuropathic symptoms and sign. Pain. 2001;92:147–57.CrossRefGoogle Scholar
  11. 11.
    Epstein JB, Emerton S, Kolbinson DA, et al. Quality of life and oral function following radiotherapy for head and neck cancer. Head Neck. 1999;21:1–11.CrossRefGoogle Scholar
  12. 12.
    Rose-Ped AM, Bellm LA, Epstein JB, Trotti A, Gwede C, Fuchs HJ. Complications of radiation therapy for head and neck cancers. The patient's perspective. Cancer Nurs. 2002;25:461–7.CrossRefGoogle Scholar
  13. 13.
    Mallick S, Benson R, Rath GK. Radiation induced oral mucositis: review of current literature on prevention and management. Eur Arch Otorhinololaryngol. 2016;273:2285–93.CrossRefGoogle Scholar
  14. 14.
    McGuire DB, Fulton JS, Park J, et al. Systematic review of basic oral care for the management of oral mucositis in cancer patients. Support Care Cancer. 2013;21:3165–77.CrossRefGoogle Scholar
  15. 15.
    Nicolatou-Galitis O, Sami T, Bowen J, et al. Systematic review of anti-inflammatory agents for the management of oral mucositis in cancer patients. Support Care Cancer. 2013;21:3179–89.CrossRefGoogle Scholar
  16. 16.
    Saunders DP, Epstein JB, Elad S, et al. Mucositis Study Group of the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology Systematic review of antimicrobials, mucosal coating agents, anesthetics, and analgesics for the treatment of oral mucositis in cancer patients. Support Care Cancer. 2013;21:3191–207.CrossRefGoogle Scholar
  17. 17.
    Nicolatou O, Sotiropoulou-Lantu A, Skarlatous L, et al. A pilot study of the effect of granulocyte-macrophage colony-stimulating factor on oral mucositis in head and neck cancer patients during X-radiation therapy: a preliminary report. Int J Radiat Oncol Biol Phys. 1998;42:551–36.CrossRefGoogle Scholar
  18. 18.
  19. 19.
    Zech DF, Grond S, Lynch J, Hertel D, Lehmann KA. Validation of World Health Organization Guidelines for cancer pain relief: a 10-year prospective study. Pain. 1995;63:65–76.CrossRefGoogle Scholar
  20. 20.
    Azevedo São Leão Ferreira K, Kimura M, Jacobsen Teixeira M. The WHO analgesic ladder for cancer pain control, twenty years of use. How much pain relief does one get from using it? Support Care Cancer. 2006;14:1086–93.CrossRefGoogle Scholar
  21. 21.
    Twycross R. Introducing palliative care. 4th ed. Oxon: Radcliffe Medical Press Ltd; 2003. p. 61–74.Google Scholar
  22. 22.
  23. 23.
    Harris RC. COX-2 and the kidney. J Cardiovasc Pharmacol. 2006;47(Suppl. 1):S37–42.CrossRefGoogle Scholar
  24. 24.
    Sjogren P, Elsner F, Kaasa S. Non-opioid analgesics. In: Cherny N, Fallon M, Kaasa S, et al., editors. Oxford textbook of palliative medicine. 5th ed. Oxford: Oxford University Press; 2015. p. 566–75.Google Scholar
  25. 25.
    Fallon MT, Cherny NI. Opioid therapy: optimizing analgesic outcomes. In: Cherny N, Fallon M, Kaasa S, et al., editors. Oxford textbook of palliative medicine. 5th ed. Oxford: Oxford University Press; 2015. p. 525–58.Google Scholar
  26. 26.
    Fred F. Ferri's clinical advisor 2017: 5 books in 1: Elsevier Health Sciences; 2016. p. 1154–5.Google Scholar
  27. 27.
    Harris JT, Suresh Kumar K, Rajagopal MR. Intravenous morphine for rapid control of severe cancer pain. Palliat Med. 2003;17:248–56.CrossRefGoogle Scholar
  28. 28.
    The Narcotic Drugs and Psychotropic Substances (Amendment) Act, 2014. The Gazette of India. Ministry of Law and Justice.
  29. 29.
  30. 30.
    Rosenthal DI, Trotti A. Strategies for managing radiation-induced mucositis in head and neck cancer. Semin Radiat Oncol. 2009;19:29–34.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2018

Authors and Affiliations

  • Charu Singh
    • 1
  1. 1.Department of Palliative MedicineAmrita Institute of Medical Sciences, Amrita Vishwa VidyapeethamKochiIndia

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